Gender affirmation surgery cap lifted

The Government plans to dramatically increase the number of gender affirmation surgeries for transgender patients, Newsroom can reveal.

The number of publicly funded surgeries performed, sometimes called gender reassignment surgery, was previously capped at three male-to-female surgeries and one female-to-male surgery every two years.

The Government has flipped the policy on its head. There will now be no cap on the number of surgeries performed, while the previous caps will become a minimum number of surgeries every two years.

Newsroom understands since the decision was made in June, eight patients have been referred to be “considered” for surgery. That is nearly half of the total 19 surgeries completed since the cap was imposed in 2004.

Documents obtained under the Official Information Act show the Associate Health Minister Julie Anne Genter sought advice on increasing the number of surgeries performed under the public health system. The documents advised the minister she could lift the cap to increase access to surgeries. A spokesperson has since confirmed this decision was taken.

James Shaw, who is covering Genter’s Associate Health portfolio while she is on maternity leave, told Newsroom the decision was a first step.

“Our health system has never met the needs of transgender New Zealanders, and that has to change,” Shaw said.

“I am taking advice on what the next steps are to improve health care for transgender New Zealanders."

A 50-year wait list

There are currently 105 people awaiting surgery in New Zealand. Seventy-nine patients are waiting for male-to-female affirmation and 26 for female-to-male surgery.

The documents say at the current rate of progress it would take 50 years to work through the waitlist, they also note the number likely underestimates the demand for treatment.

It's noted that treatment is likely to improve the health and wellbeing of transgender people, which is “markedly worse” than the general population’s.

A 2012 survey of 8500 youth found approximately 40 percent of transgender students had “significant” depressive symptoms and nearly half had self-harmed in the previous 12 months. One in five had attempted suicide in the last year.

The cost of change

The surgeries are not cheap, and are more expensive in New Zealand. The country has not been able to provide male-to-female surgery since the retirement of the only specialist in 2014. Since then, a small number of publicly funded surgeries have been performed overseas.

These are paid for from the High Cost Treatment Pool, a fund available for one-off treatments not otherwise funded by the public system. The funding is then used to pay for surgery either in New Zealand’s private system or overseas.

The funding pool is not capped and its budget fluctuates based on need.

New Zealand has never had the expertise to perform female-to-male surgeries, which the briefing describes as “more complex”.

Newsroom understands the Government is working to have surgeries performed in New Zealand. The documents note there is now one surgeon with the necessary training here, but they are not currently working.

Ministry of Health figures put the average cost of male-to-female surgery at $53,382, with individual surgeries costing between $25,587 at their lowest up to $81,975.

The costs for female-to-male surgery are higher, averaging $218,892, with a range of $45,169 to $525,034.

But these costs also include post-surgery complications. The ministry noted that two of the seven female-to-male surgeries done since 2004 resulted in “significant complications” resulting in bills of over $500,000 each. It is hoped when surgeries are performed here, the likelihood of complications will reduce, reducing the cost.

The High Cost Treatment Pool budget is set based on the number of surgeries performed and therefore fluctuates from year to year. The ministry confirmed there is no chance of hitting a funding ceiling because the pool itself is not capped.

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